|
APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />WaterUnder floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptori Clarif ier
<br />TOP OUT
<br />Water Piping
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />,/d1-Water Service q/o,l/r*6.zz---s
<br />Lawn Sprinkler t 'l*
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq //ul/rr t tYU e{y)-la--
<br />5\ tr,tq,tyNotesRemarks, Etc
<br />Final Gas Test
<br />Meter Release
<br />OWNI:N BUTLDT]R DELCARATION
<br />I hcrchy llftD uftid ,cnrlry oi rriury lhlr I um cicnrnl l',onr rhc O)nrrarkn: Li.cisc Liw rot $c tull(Ning .c!$. (S.c ?0.11 5
<br />Bu\inc$ rnd Profcsion Cqlc) ny ciry or counry ehrh rquitus d ,rflnn (, cnn(ruc|. nltcr imnrrt. dc xnilh ur rcnrir Jny
<br />(ru.rur.. pri(,b ns h$m.., dls rcquncs th,,0mli.aDt ror su.h p.flnir lo rilc x sirtud dar.nf,nr rh r hcor shc t li.ensd Putsuanr
<br />ro rhc pmvisions ol rhc Conracro\ t-iccn{d liw (Chnrcr 9, C.nnncn.,.8 wnh Scclnin ?0Oo ol Dilisn'n I otlhc Busnc$ und
<br />It.lc$n,n\ Codc)orrhar h. or\hr iscr.Dpr rhcrcfrotrritrd rhchdsis Ior rhc.llc8cdcxcnrpri.n. AnrliohrionofSc.riotrl03l.5lt)!ny
<br />.ftlic,nr r(tr. pciinir suhicchrhc rfplicrnt h aciviltcn0llyoi.or morc'hln rilc hundrd doUnr\ (s51x)).
<br />-1.
<br />es owner ol rhc trcF.ty. or nt enghr.s wilh wag.! B llEn $b ompcnsrhl! will do de worL ud ltE stnElw h ml
<br />inLndai r oftircd lor $lc (Se.?044. Bosiftss and Pmtcsions Codc TIE ConrBrol3 Lrc.ns tt* docs nol aplly to an owrcr of
<br />tlE p6Fny who boildeor in0bwstlE@n ad who des ch wrt himsclf or h.mlf or finlS! hir d hd osr.mphy.ca.
<br />prclidcd rhlr such in{ftEBnr. @ mr i.rcn&d notrcr.d lor sL lf, hog.w, rE hrildinS or inpmrft h eld *iui! oi. rae.fotr?t h.. rlE O*M Builhi ui! haw 0E hldcn ol poviis thd }E or ,c dll er hiild m hpmE lhe pspdly aor dE F Ins of
<br />-1.
<br />,s .sn.r of rhc In'p.ny, !n crclusiwly &nrEcline wirh liccnEi contncks r. drsio.r rlr pnrjRt (Scc. 7044. Burim$
<br />ud h.n$ia Codc: Thc Ctrok!.!.ir Li..n* Lrw ddr mr aml, to anown.r of[op.ny who builds or imrovcs rhcmn.
<br />rnd eho o nck tor such !mi(G wirh . Conlmdons) ltcnsd purs@t 16 rlE Conrrdo/i Lic..sc t,w).
<br />I dm.kml, undn Scclio
<br />lrrl. (r$ cr
<br />EO8trEBASTMIENTA]ION
<br />DE(]ldaAuo!
<br />I hcrcby lftrrmunder p.nalryotpd!ryoncolrhc folb*in8 d(bftlions:
<br />l.nhn (iilc.ldrhc ncrlonnim.olrhc *ork rorshi.h rhc ptflnir n is\t.d
<br />_lhav.and{iUmi ain workcB' coq,cnsrtion insurlncc. !s rcqlircd hyS*rioo 1700olrhc bbo. C.d.. aor lhc l,dfolr1@eof
<br />rhc mrt f.! whi.h rhis Fmn is hsu.d. My eorlcs, cohpcnslion insure. cuir .id Pdlty rumh.r m:
<br />-l
<br />ccnify thlr in rhc perlo,tutu. ofrhc worl fr which rhi\ p.roii ir ksucd. I sfiallnol cmploy lny pcson i. s.y dnnd
<br />s as b tE6m subjd ro rhc *orkcn c.mpctrsrion laws of Califomia. ..d os@ rhat it I should h.om subi{ lo ll[
<br />so.t.N' mmpcns.rion pmvnions ot Selion 3700 of lh. Lstor Code. I shlll. fonhwith .om y wth lhos povkions .
<br />WARNING: FajhE to surc lorkcrs omp€nsaln,n co!€nsc is unla*ful, ,trd shdl subjel an cn{lortt to oinidl laEhts &d
<br />ctrrl ,ln.\ u! n' urc hundrcJ lhou\drxl dnllaF l$,|'(r,urD. io rddirion nr rhc.os orco,nFnsarion. d.nEScl as provijcd lor lhc
<br />sc.rnn lrr?6orrh.lnhr('o.lc i' d.{!'d o,6v\ lcc\D.,.: V;,t|iatfra 4uov,/ \ LI(EMIIL(I0dINAIJI)B/ \ nE(r Af,,\Tl(JN
<br />I hcrch) !fijrnr utrd(r pcnulry,,ftrrJdry{hr I rtr,l'.tn{t undu pn,vntun ofChaprcr 9(ommmin8 wirh Serio. 7m0 ) .l Division l
<br />Li.cnsc Clas:_Li..ns. Nun$ct tcrz3Q5o
<br />€ \i?4!d.vo O<l+oa
<br />I lEcby .l!rm !nd6 ocelry ol rerjlry
<br />isslcd (S€. 309?. Civ, C. ),
<br />lcnding l8cmy tu rhc p6tormmc or thc vork lor rhich lhh lsmir h
<br />AISLICANI.DESdAAIION
<br />I hdcl,y ultinD u nd.r ,enalty oI pcrjry .nc of rhc f{nk,win8 dcchrrrions:
<br />Dcm,lnion Pc.nrirs A$.rlos Nol incd io. FcdcrdlRcculllions ('l nt 40, Pnn6)
<br />Rcquircd t llcr of flotifi calhn
<br />!lcd'r, # rhc rcdcrl ksulxnon\ R8ril'n! a\b.n.1 E'm!.IJrc not {mlrobk li,lh* nI',r.cr
<br />2q \urr,,# , ** *.d *'s anrlicornn and na,c rhur rhc atnw inn,marion ir.oBr. I e8@ ro.onpry with ou ciry and colnry
<br />ord'ntrne)fuld Srd. tj$! rchrms to huildins (nn{rucrion. and hcEby lurlt)rtu i.pr*nlaliws ofrhis Ciryand Coutrly ro cnr.r upon dt
<br />"t-* n/d.it(.J p-ri, r.. o\perotr punoi(
<br />odv
<br />PLUMBING-INSPECTOR RECORD
<br />Waste & Vent
<br />Gas Service
<br />FINAL
<br />oa rhc Busims rnd Pmf.sions Code, od my ltc.r is in full torc $d .fi.cr
<br />f------T------
<br />fI
<br />I
<br />tT rI- 1
<br />I
<br />i-
|